Psychiatric‐related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services

Singh, Parvati; Chakravarthy, Bharath; Yoon, Jangho; Snowden, Lonnie R.; Bruckner, Tim A.

doi:10.1111/acem.13812

Cited by 14 publications

(11 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We observed no relation between county-level psychiatric ED visits and volume of mental health patients seen at CHCs. However, other work by our team finds fewer individuallevel psychiatric ED revisits when mental health visits and patients at CHCs increase (33). Taken together, these findings indicate that CHC mental health visits may hold stronger implications for high ED utilizers than for overall psychiatric ED visitors (33).…”

Section: Discussionmentioning

confidence: 53%

Psychiatric Emergency Department Visits After Regional Expansion of Community Health Centers

Bruckner

Singh

Chakravarthy

et al. 2019

Self Cite

View full text Add to dashboard Cite

Regional primary health care system capacity may affect the demand for psychiatric visits to the emergency department (ED). In the United States, community health centers (CHCs), which serve low-income regions regardless of individuals' ability to pay, expanded primary care services by over 70% in the past decade. No research, however, evaluates whether this expansion affects overall psychiatric ED visits. This hypothesis is tested in 143 U.S. counties that expanded CHC services.Methods: For the years 2006 through 2011, 18.84 million psychiatric outpatient ED visits were aggregated by county-year for the 143 U.S. counties with a participating CHC. The rate of psychiatric ED cases in a county-year is the dependent variable. Two independent variables were examined: total patients seen at CHCs and total patients receiving mental health services at CHCs. Fixed-effects regression methods controlled for county effects, year effects, and other health care and sociodemographic factors.Results: Psychiatric ED visits fell below expected levels in county-years where the volume of overall CHC patients rose (coefficient=-0.059; standard error=0.027, p=0.03). Findings indicate no relation between the volume of mental health patients seen at CHCs and psychiatric ED visits.Conclusions: An increase in general primary health care to an underserved population, in the form of CHCs, corresponds with a decline in psychiatric ED visits. This result coheres with a recent Medicaid expansion experiment in which increased access to general primary care reduced the prevalence of undiagnosed and untreated depression. Findings, if replicated, may hold policy implications for regional health systems.

show abstract

Section: Discussionmentioning

confidence: 53%

Psychiatric Emergency Department Visits After Regional Expansion of Community Health Centers

Bruckner

Singh

Chakravarthy

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Researchers further note that the current investment in FQHCs, whose most recent annual outlay exceeds $5.0 billion, may fall below sufficient levels given the prevalence of mental health needs in these underserved communities. Whereas a thorough cost‐effectiveness analysis remains outside of the scope of this paper, we encourage more rigorous evaluations of the efficiency of FQHC expansions . We also note that the penetration rate of FQHCs in many communities remains low.…”

Section: Discussionmentioning

confidence: 96%

“…Federally Qualified Health Centers (relative to other health care options) may compel low‐income populations to seek primary care and therefore reduce the need for urgent care . Empirical evidence of the extent to which FQHCs may substitute for use of ED care, however, remains scarce . We focused on the long‐standing African American/ white youth disparity in reliance on the ED for psychiatric care and tested whether rapid FQHC expansions from 2006 to 2011 reduced this disparity.…”

Section: Discussionmentioning

confidence: 99%

African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers

Bruckner

Singh

Yoon

et al. 2019

Health Services Research

Self Cite

View full text Add to dashboard Cite

Objective: To test whether rapid expansion of mental health services in Federally Qualified Health Centers (FQHCs) reduces African American/white disparities in youth psychiatric emergency department (ED) visits. Data Sources: Secondary ED data for psychiatric care for 3.3 million African American and white youth in nine states, 2006-2011. We used the HCUP SEDD and SID. We obtained FQHC service data from the Uniform Data System. Study Design: The psychiatric ED visit is the dependent variable. Logistic regression methods control for individual risk factors for ED use, as well as county-level health system factors and county and year fixed effects. Key independent variables include indicators of mental health service capacity in FQHCs in a county-year. Data Extraction Methods: We extracted ED psychiatric visits for 3.3 million African American and white youth in nine states, 2006-2011, from the HCUP SEDD and SID, and FQHC data from the Uniform Data System. Principal Findings: Overall mental health visits at FQHCs correlate positively with psychiatric ED visits among African American youth. However, increases in the number of mental health visits per FQHC patient corresponds with fewer outpatient psychiatric ED visits among African American youth, relative to white youth (odds ratio = 0.96; 95% CI = 0.94, 0.98). Conclusions:Increases in the intensity of services offered per mental health patient at FQHCs-rather than increases in overall capacity-may reduce African American youthʼs overreliance on the ED for psychiatric care.

show abstract

“…Strong continuity of medical care is a well-known target in all healthcare reforms [ 61 , 62 ], especially for patients with complex health conditions living in disadvantaged social contexts [ 52 , 63 ]. By contrast, good continuity of care is usually associated with better health outcomes [ 30 ], contributing to a reduction in high ED use [ 64 ] and hospitalizations [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders

Gentil

Grenier

Vasiliadis

et al. 2021

IJERPH

View full text Add to dashboard Cite

Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.

show abstract

Psychiatric‐related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services

Cited by 14 publications

References 35 publications

Psychiatric Emergency Department Visits After Regional Expansion of Community Health Centers

Psychiatric Emergency Department Visits After Regional Expansion of Community Health Centers

African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers

Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders

Contact Info

Product

Resources

About